The Medical School of the University of Liverpool is at a critical phase in its development. Through the 1990’s and 2000’s it improved from being at the bottom of the league tables, with graduates who were imperfectly prepared for their pre-registration house officer posts, to being at the top of the league tables with the best prepared graduates. In more recent years it has performed badly in the National Student Survey, and has, consequently fallen down towards the bottom of the league tables. The graduates are still well prepared, but the sense of cohesion and common endeavor within the medical school has been lost. This is manifest in several ways, but the trigger for this study was a difficulty in recruiting senior clinicians to teach our medical students. A series of semi-structured interviews was held with a purposive and convenience sample of fourteen senior clinicians. Nine of the participants were members of full time University staff with honorary National Health Service (NHS) contracts, and five were full time NHS clinicians with honorary University contracts. The gender balance was equivalent to that of the senior clinicians in our region (60M:40F). The approach taken in this study is a critical realist approach, whereby it is recognized that individual participants experience and interpret reality in their own particular ways. The factors that individuals consider to facilitate or frustrate their involvement in teaching undergraduate medical students are, at best, a proxy measure for the actual constraints and enablers. The themes extracted from the interviews were studied using a constructivist grounded theory method. The major enablers for being involved with teaching undergraduate medical students were the students themselves, and a desire to give them the best possible experience. The major constraints were a lack of clarity about expectations, a lack of recognition for those involved in teaching, and the difficulty of balancing competing imperatives. The two new elements uncovered in this study are the influence of colleagues (for good or ill) and the relative unimportance of “time” itself. A series of recommendations are made which involve leadership, communication, recognition, and, crucially, ensuring the agency of those who wish to be involved in educating undergraduate medical students. Awareness of these issues should strengthen the medical school in its resolve to improve the student experience, and rebuild our community of practice.